Here’s a handful of moral statements that, I guess, many people would take to be trivially true: We ought to save lives where possible; Saving more lives is better than saving fewer; It is a good thing to save lives as efficiently as possible; Saving lives is more important than improving tolerable lives.  Nothing too controversial there, I don’t expect.  (OK – there may be rough edges, but this is a blog, not a peer-reviewed paper, dammit…)

I mention these because I’ve just been reading Rose George’s The Big Necessity: Adventures in the World of Human Waste.  It’s as much of an eye-opener as it as a nose-closer.  Take this, for example, from the introduction:

2.6 billion people don’t have sanitation […] Four in ten people have no access to any latrine, toilet, bucket or box.  Nothing.  Instead, they defecate by train tracks and in forests.  The do it in plastic bags and fling them through the air in narrow slum alleyways.  If they are women, they get up at 4 a.m. to be able to do their business under cover of darkness for reasons of modesty, risking rape and snakebites  Four in ten people live in situations where they are surrounded by human excrement, because it is in the bushes outside the village, or in their city yards, left by children outside the back door.  it is tramped back in on their feet, carried on fingers onto clothes, food and drinking water

The disease toll of this is stunning.  A gram of faeces can contain 10 million viruses, 1 million bacteria, 1000 parasite cysts, and 100 worm eggs. […] Poor sanitation, bad hygiene and unsafe water – usually unsafe because it has faecal particles in it – cause one in ten of the world’s illnesses.  Children suffer most.  Diarrhoea […] kills a child every fifteen seconds. […] Public health professionals talk about water-related diseases, but that is a euphemism for the truth.  These are shit-related diseases.

Now go back to the moral claims with which I started this post.  If you think that they’re at least in the vicinity of correct, then it seems that there would be some hard questions to answer about our health priorities.

Take, for example, the idea that there’s a moral duty to carry out medical research.  Given that this research will use resources, and (one hopes) would generate medicine the use of which would also swallow resources, one might wonder whether those resources could be more efficiently put to work.  Notably, one might think that, if it’s important to save someone from dying from, say, cancer, then that’s because we have an obligation to save lives.  And yet we could save many more lives by not doing the research and spending the time and money on sanitation instead – a latrine with a composter is cheap, and might save the lives of a quarter of the children in a village in rural Kashmir for very little outlay.  It’d also reduce the stress on whatever health services are already there, because people won’t be made ill from cholera and other shit-related diseases if they do survive infancy.

So given a finite source of time and money, it doesn’t seem crazy to think that perhaps the cancer research ought to be put onto a back burner.  If you take saving human lives seriously, then – brutally – it’d be nice if more people died of cancer, strokes or whatever – because at least they’d have lived long enough to suffer from them.

Now think of the claim that saving lives is more important than improving tolerable lives.  Presumably, a human life is a human life, no matter where or whose.  This, too, implies a radical conclusion – we perhaps ought to spend a bit less on, say, NHS fertility treatment (which is, when it comes to the crunch, a lifestyle thing), physiotherapy, and the like, and spend the money on defecation in Lagos, or Kolkata, or wherever.

Sanitation is not so sexy, but it is effective.  A latrine is easy and cheap.  Even the poorest people, it turns out, will happily pay for one as long as you persuade them that it’d be a good thing.  And shit’s useful.  It can be put to work. 

So here’s an idea: if you’re really concerned about saving lives and increasing welfare, spend money not on cancer or glaucoma or diabetes, but on toilets and composters.  If you really want to do research, have a look at cheap means of installing resilient parabolic mirrors that can heat the poo, pasteurise it, and make it safe to spread on African fields.  As a bonus, the soil’ll be revivified and more food’ll grow.  (Here’s another snippet from The Big Necessity: Joel works at a plant near Washington DC that makes fertilizer from human shit.  “I ask him if he’d use it on his garden, and he knows that I’m actually asking if its safe.  ‘Sure I would.  And I’d have my kids roll around in it.  No problem.'”)

I realise I’m being a bit zero-summish here.  It’s not a matter of research or latrines, IVF or clean water.  You can have both.  But it’s an interesting thought-experiment to see whether we have the right priorities.  If we had a hundred thousand pounds to spend on health, where would it go?